Teaching about chronicity in medical schools - A review of the current situation.

In recent decades, progressive population aging in developed countries has led to a significant increase in the number of people with at least one chronic medical condition. As a result, acquiring knowledge about chronicity in medical school is key for physicians to be able to provide proper management for these patients. However, the presence of chronicity in educational curricula is scarce and highly variable. On the one hand, this work consisted of a review of the educational programs of the main medical schools on each continent with the aim of identifying whether they included chronicity and, on the other, a literature review focused on identifying educational projects in the field of chronicity. The presence of chronicity in most medical schools' curricula is marginal and only a few universities include specific skills or competences linked to chronicity. In most cases, this topic appears as a global, cross-curricular competence that students are supposed to acquire over the course of their entire education. The literature review retrieved 21 articles on innovative teaching projects on chronicity. Direct contact with chronic patients, most times as "health mentors," the role of the student as a teacher, and continuous evaluation and feedback from all participants are the main characteristics of the projects analyzed. Some previously published experiences support the usefulness of innovative methodologies for better approaching this capital field in current medical practice. Despite the current situation in which chronic patients consume most healthcare resources, the presence of chronicity in medical schools is marginal. However, a literature review did identify some useful experiences for improving education on chronicity in medical schools. Medical schools should change their academic curricula and redirect them towards providing students all the necessary tools for improving their knowledge on chronicity.

[Efficacy and safety of ezetimibe in vascular risk units]. / Eficacia y seguridad de ezetimiba en unidades de riesgo vascular.

OBJECTIVES: This study was intended to assess the efficacy and safety of ezetimibe when taken alone or combined with statins in a specialized care setting and under standard clinical practice conditions. PATIENTS AND METHODS: A multicenter, retrospective study in patients with dyslipidemia seen in a specialized outpatient clinic and treated with ezetimibe for at least 12 weeks. Patients were divided into three groups: monotherapy, add-on ezetimibe, and initial coadministration. RESULTS: A total of 217 patients (mean age 59 years; 37% ≥65 years) were enrolled. Of these, 61% were women, 21% had type 2 diabetes and 20% had had a previous cardiovascular event so that the lipid lower drug treatment should satisfy the objectives of secondary prevention. Mean change in the monotherapy group (n = 92; mean 41 weeks) included: decrease of LDLc of 28% (P <.001). In the group where ezetimibe was added on to different ongoing statins (n = 94, mean 73 weeks), mean changes was as follows: LDLc -34%, significant change as compared to monotherapy (P < .001). In the group with initial coadministration of ezetimibe with different statins (n = 31; mean 118 weeks), mean change included: LDLc -53% (P < .001). Overall, 64% of patients reached the thereapeutic objective proposed for the Adult Treatment Panel III (ATPIII) for cLDL. In patients with low risk (LDLc < 160 mg/dL), moderate risk (LDLc < 130 mg/dL) and high-very high risk (LDLc < 100-70 mg/dL), the percentage of patients who reached the therapeutic objective was 81%, 64% and 44%, respectively. CONCLUSIONS: Under standard clinical practice conditions, ezetimibe appears to be effective and safe for the control LDLc, thus making it possible to reach the therapeutic objectives proposed by the ATP-III in a high number of patients, especially when associated to statins.

Nutritional Risk and Mortality at One Year for Elderly Patients Hospitalized with Nonvalvular Atrial Fibrillation. Nonavasc Registry.

OBJECTIVES: To determine whether nutritional risk is associated with the mortality of elderly patients hospitalized with nonvalvular atrial fibrillation (NVAF). DESIGN: Prospective, multicenter cohort study. SETTING: Internal medicine departments in Spain. PARTICIPANTS: Inpatients >75 years with NVAF. MEASUREMENTS: We measured the thrombotic and hemorrhagic risk at admission using the CHA2DS2-VASc and HAS-BLED scales, respectively, and the nutritional risk with the controlling nutritional status (CONUT) index. We established 4 degrees of nutritional risk: null (CONUT score 0-1 point), low (2-4 points), moderate (5-8 points) and high (9-12 points). We also conducted a 1-year follow-up. RESULTS: We included 449 patients, with a mean age of 85.2(5.2) years. The nutritional risk was null for 70(15.6%) patients, low for 206 45.9%), moderate for 152(33.8%) and high for 21(4.7%). At the end of one year, 177(39.4%) patients had died. The score on the CONUT index was higher for the deceased patients (4.6 vs. 3.6, p<0.001). The CONUT score (HR, 1.076; 95%CI 1.009-1.148; p=0.025), the Charlson index (HR, 1.080; 95%CI 1.017-1.148; p=0.013) and the presence of pressure ulcers (HR, 1.700; 95%CI 1.028-2.810; p=0.039) were independently associated with increased mortality at one year of follow-up. The prescription of oral anticoagulants at discharge was associated with lower mortality (HR, 0.440; 95%CI 0.304-0.638; p<0.001). CONCLUSIONS: More than a third of elderly patients hospitalized with NVAF have a moderate to high nutritional risk. These patients have greater mortality at the end of one year.

[Do we define the COPD correctly?]. / Definimos correctamente la EPOC?

Chronic obstructive pulmonary disease (COPD) is a very common disease which prevalence is increasing and in a nearly future it will represent a socio-sanitary problem. This article s objective is to make a reflexion about the concept COPD, for the physicians contribute to their divulgation to the population and very specially to help to the tobacco desertion. Besides we want to reveal that the term has been well-finished due to the advance in the knowledge of aetiology, physiopathology, and radiology techniques. Although, we think that the acronym still includes entities with a very different features. We hope to clarify this concept in the future, establishing different phenotypes and mainly with molecular biology.

Hospital at home for acute respiratory patients.

BACKGROUND: The issue of "hospital at home" (HAH) for acute respiratory patients is one that is still being debated, partly because economic, cultural and health service differences between locations imply that HAH schemes need to be tailored to local situations. The aim of the present study was to analyze the feasibility and effectiveness of HAH for patients with acute respiratory disease at our institution. METHODS: Of all the patients admitted to our institution via the emergency department during a 34-day subject enrollment period, 25 with diagnoses of respiratory infection, pneumonia, pulmonary insufficiency or exacerbated chronic obstructive pulmonary disease who were living within 25 km of our center and who were willing to receive HAH care were assigned to HAH. Fifty sex-matched controls with the same diagnoses were given conventional hospital care (CHC) as inpatients. The dependent variables evaluated included time to discharge, readmissions within 3 months and deaths within 3 months. RESULTS: There were no significant differences between the HAH and CHC groups with regard to age, diagnoses, physical and analytical findings, or co-morbidity, or with regard to deaths (HAH 16%, CHC 10%) or readmissions (HAH 17%, CHC 24%). Time to final discharge was significantly shorter for HAH patients (7 days) than for CHC patients (12 days). Some 95% of the HAH patients were satisfied and would choose HAH again. CONCLUSIONS: HAH seems feasible for appropriately selected acute respiratory disease patients presenting in our emergency department. It frees hospital beds for other patients, its readmission and mortality rates are no higher than for conventional hospitalization, and, in general, it is favorably evaluated by patients.

Ultrasound in the diagnosis of asymptomatic hyperuricaemia and gout. / La ecografía en el diagnóstico de la hiperuricemia asintomática y la gota.

The increase in serum urate concentrations (hyperuricaemia, ≥7.0mg/dL) creates crystals, which promote inflammation and joint lesions. Ultrasonography can reveal these urate deposits. The presence of crystals suggests that a patient with hyperuricaemia is actually experiencing asymptomatic gout, and that a patient with gout without subcutaneous tophi could experience tophaceous gout. The information offered by ultrasound (double contour sign and hyperechoic concretions mimicking clouds) enables a more specific classification of hyperuricaemia and gout. Additionally, this information can lead to relevant changes in terms of the diagnosis and therapeutic approach for patients with hyperuricaemia and gout.

Antithrombotic treatment in elderly patients with atrial fibrillation. / Tratamiento antitrombótico en el paciente anciano con fibrilación auricular.

Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF.

Evolution of left ventricular hypertrophy and function during long-term treatment of systemic hypertension with enalapril.

Continued treatment of hypertensive patients with enalapril reduced left ventricular (LV) hypertrophy steadily over a period of 5 years (by which time gross structural parameters were normal) and produced no further reduction during the following 2 years. Temporary suspension of treatment after 5-year follow-up gave rise to an increase in blood pressure, and to deterioration of LV isovolumic relaxation time and deceleration of the ventricular filling E wave, both of which chiefly reflect the active relaxation of the ventricle.

[Left ventricular structure and (systolic and diastolic) function in hypertensive patients without atherosclerotic coronaropathy]. / Estructura y función (sistólica y diastólica) ventricular izquierda en hipertensos sin coronariopatía aterosclerosa.

INTRODUCTION AND OBJECTIVES: Electrocardiographic (ECG) ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy and/or ischaemia and a higher cardiovascular risk. Hypertensive patients with typical or non-typical chest discomfort and a normal coronarographic study underwent an echocardiographic and Doppler study in order to assess left ventricular structure and (systolic and diastolic) function. MATERIAL AND METHODS: Hypertensive patients with ST-T changes were classified as follows: Control group (CG) was made up of 12 hypertensive patients (6 women, 6 men, mean age 59.6 +/- 7.4 years) with normal ECG; Group A (GA), 10 patients (6 women, 4 men, mean age 63.1 +/- 6.8 years) with ECG image of strain; Group B (GB) (9 women and 8 men, mean age 61.3 +/- 10.1 years) with other ST-T alterations. We assessed by echocardiographic and transmitral flow Doppler study left ventricular structure and (systolic and diastolic) function. RESULTS: Interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass and mass index were significantly higher in the GA and GB than in the CG, without differences between GA and GB groups. No differences in left ventricular systolic function parameters were observed between the groups. In comparison with the CG, the GA and GB showed significant differences in E wave deceleration velocity and deceleration time, A wave deceleration time and isovolumetric relaxation time. Between GA and GB differences were observed in A wave deceleration time and isovolumetric relaxation time. CONCLUSIONS: In hypertensive patients without atherosclerotic coronaropathy, ST-T changes identify a group with greater left ventricular mass and worse left ventricular diastolic function. The patients with a ST-T strain pattern showed the impaired diastolic function.

[Electrocardiographic patterns in hypertensive patients without atherosclerotic coronary disease. Influence of the left ventricular mass]. / Patrones electrocardiográficos en hipertensos sin coronariopatía aterosclerosa. Influencia de la masa ventricular izquierda.

BACKGROUND: ECG ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy or ischaemia. Hypertensive patients with abnormalities in ST-T segment in DI, aVL and/or V5-V6 underwent an echocardiographic study in order to assess left ventricular structure. All of them, in addition to the electric changes, showed typical or non-typical thoracic discomfort, showing a normal coronariographic study. METHODS: Hypertensive patients with ST-T segment changes were classified as follows: group A, 12 patients (8 women, 4 men, mean age 63.6 +/- 7.2 years) with ECG image of left ventricular overload pattern; group B, 9 patients (3 men, 6 women, mean age 62.3 +/- 6.3 years) with flat ST segment depression; and group C, 10 patients (3 men, 7 women, mean age 62.4 +/- 9.7 years) without changes on the ST-T segment with flat or negative T wave. Control group is made up 12 hypertensive patients (7 women, 5 men, mean age 61.6 +/- 7.6 years) with normal ECG. We assess by echocardiography interventricular septal thickness (IVST) and left ventricular posterior wall thickness (PWT) in mm, left ventricular end-diastolic diameter (DTD) in mm, left ventricular mass (LVM) in grs, and the mass index (MI) in g/m2. RESULTS: IVST, PWT, LVM and MI were significantly (p < 0.05) higher in the groups A, B and C than in the control group. No statistically significant differences were observed between the A, B and C groups. Stepwise discriminant analysis showed that the only parameter with independent value for discriminating between control, group and group ABC (the union of groups A, B and C) was IVST. CONCLUSION: In hypertensive patients without coronariopathy, ST-T changes identify a group with greater left ventricular mass. The different electrocardiographic patterns considered were not associated with a significantly different left ventricular mass.

[Myocardial structure and study of arrhythmias during ambulatory electrocardiographic monitoring in mild essential hypertension]. / Estructura miocárdica y estudio de las arritmias durante el registro electrocardiográfico ambulatorio en la hipertensión arterial esencial ligera.

BACKGROUND: The development of arrhythmias in patients with high blood pressure has been related to the presence of left ventricular hypertrophy. The aim of this study was to determine the presence and relationship between left ventricular hypertrophy and arrhythmias in patients with slight arterial hypertension. METHODS: One hundred and two individuals (54 males and 48 females), 51 of whom were hypertensive and 51 normotensive, were included in the study. None of the subjects had received antihypertensive treatment. Twenty-four hour electrocardiographic registry, echocardiogram and ambulatory blood pressure monitorization were performed. RESULTS: Fifty one percent of the hypertensive individuals had left ventricular hypertrophy (LVH) versus 18% of the normotensive subjects. Supraventricular and ventricular arrhythmias were equally frequent in the hypertensive and the normotensive subjects as were the episodes of ST depression (7.8% versus 9.8%, respectively). Both types of arrhythmias were correlated with the age of the hypertensive subject. Twenty-seven of the hypertensive subjects had white coat hypertension. The left ventricular mass in these subjects was similar to that of the hypertensive subjects with maintained hypertension and both were greater than the normotensive subjects. In regard to the frequency of LVH in the hypertensive subjects with maintained hypertension, 15 (62.5%) did not differ from either the LVH in white coat hypertensive subjects 11 (40.7%) or in regard to the frequency of supra and ventricular arrhythmias. On multivariate analysis both types of arrhythmias correlated with the index of ventricular mass in the hypertensive patients in both males and females. CONCLUSIONS: Left ventricular hypertrophy may develop early in hypertension although it is not related to a greater frequency of arrhythmias in patients with slight arterial hypertension.

[Different arterial pressure patterns during ambulatory monitoring in hypertensive patients of both sexes are not associated with different cardiovascular impact]. / Las diferencias en el comportamiento de la presión arterial durante la monitorización ambulatoria en hipertensos de ambos sexos no se asocian a diferente repercusión cardiovascular.

BACKGROUND: To establish if the differences between male and female hypertensives, with similar characteristics, are associated with different cardiovascular damage. PATIENTS AND METHODS: We compare a group of 27 mild hypertensive males with another one of 24 females with similar characteristics. A 24-hour ambulatory blood pressure monitoring, a 24-hour ECG holter, an echocardiography and eye funduscopy, were done to all the patients. RESULTS: The mean of 24 hour-systolic blood pressure (p < 0.01), the daytime and night-time systolic blood pressure load (p < 0.05), and the mean of systolic blood pressure daytime, were significantly are not higher in male than in female hypertensives. Neither echocardiographic differences nor frequency of arrhythmias were observed between both groups. 66.7% of the women had left ventricular hypertrophy vs 37% of the men, without significant difference. 40.7% of the male had rethynopathy I-II vs 50% of the female. Left ventricular mass index correlated with different parameters of the ambulatory monitoring in the multivariate analysis. Body mass index and daytime systolic blood pressure load classified correctly 89% of the male-group in with or without hypertensive rethynopathy. The body mass index, age and 24-hour maximal systolic blood pressure, classified correctly 87.5% of female hypertensives in with and without hypertensive rethynopathy. CONCLUSIONS: The differences in the ambulatory blood pressure monitoring between male and female mild hypertensive patients, were not associated with different cardiovascular damage. We emphasize the importance of the body mass index in the development of hypertensive rethynopathy in both sexes.

[Relation between left ventricular hypertrophy and retinal vascular changes in mild hypertension]. / Relación entre la hipertrofia ventricular izquierda y la lesión vascular retiniana en la hipertensión arterial esencial ligera.

BACKGROUND: To evaluate the possible relation between left ventricular hypertrophy and vascular changes in retine, in patients with mild hypertension. PATIENTS AND METHODS: We established a group with 51 hypertensives (27 males and 24 females), with essential mild hypertension, which had never been treated. An ambulatory monitoring blood pressure, 24 hours electrocardiographic monitoring, echocardiography and funduscopy were realized to all of them. RESULTS: Fifty-five per cent of the hypertensives had retinopathy grades I-II. We established two subgroups with and without retinopathy. The age, systolic, diastolic and mean blood pressures, so as body mass index higher in the group with retinovascular damage. No significant differences were observed in the ecographic parameters between two subgroups except the interventricular septal thickness (10.5 +/- 2.1 min in the subgroup without vs 11.1 +/- 2.3 mm in the subgroup with retinovascular damage) (p < 0.05). As 24-hour maximum and mean systolic and diastolic blood pressure, daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), daytime and night-time DBP load, as daytime SBP load were higher in the hypertensive patients with retinovascular changes. There was echocardiographic left ventricular hypertrophy in 51% of the hypertensive patients, without differences between both subgroups of hypertensive patients. Body mass index (g/m) correlated significantly (p < 0.01) with the retinovascular damage. In the multivariant analysis, male as well as female, the funduscopy correlated with left ventricular mass index (g/m2). We established a discriminant function to separate hypertensives with and without left ventricular hypertrophy and another to separate hypertensives with and without retinopathy. Both functions included body mass index and maximum SBP, so as daytime SBP load and nighttime mean DBP to the left ventricular hypertrophy function. CONCLUSIONS: Left ventricular hypertrophy and retinovascular damage appear early in the course of blood pressure elevation and both changes develop in parallel. Our results indicate that there exists a relation between both cardiac and vascular changes in the hypertension. Body mass index and maximum SBP, appear to be important determinants of structural adaptation in mild hypertension.

[The midterm inefficacy of 2 different dosages of chlorthalidone (50 and 25 mg/day) in the regression of left ventricular mass in arterial hypertension]. / Ineficacia a medio plazo de dos diferentes dosificaciones de clortalidona (50 y 25 mg/día) en la regresión de la masa ventricular izquierda en la hipertensión arterial.

BACKGROUND: To evaluate the antihypertensive efficacy at rest and under exercise, and the modifications induced on the left ventricular mass in patients treated with two different doses of a diuretic. METHODS: Fifty hypertensive males, mean age 51 years, received during nine months 50 mg/day of chlortalidone and thirteen 25 mg/day for the next nine months. Baseline tension control and echocardiogram and each three months after starting therapy during the two phases of the study were performed. Thickness of the interventricular septum and posterior left ventricular wall in mm, left ventricular mass index in g/m2 were determined. RESULTS: The baseline septum was 15 +/- 3.3 mm, 14.6 +/- 3.1 mm at 9 months and 14.5 +/- 2.9 mm at 18 months, the posterior wall was 14.1 +/- 3.1 mm at baseline, 13.7 +/- 2.9 mm at 9 months and 13.6 +/- 2.9 mm at 18 months. The left ventricular mass index was 153 +/- 45 g/m2 at baseline, 146 +/- 36 g/m2 at 9 months and 144 +/- 39 g/m2 at 18 months. The antihypertensive efficacy at rest and under exertion was similar for the two doses of chlortalidone. CONCLUSIONS: After nine months of therapy the two doses of chlortalidone (50 and 25 mg/day) failed in reducing left ventricular mass. However, the design of the study and the small number of subjects enrolled introduce several important limitations to both the interpretation of our results and conclusions.

[Comparative study of the lipid profiles in the health staff versus the non-health staff at a health center]. / Estudio comparativo del perfil lipídico del personal sanitario con el del personal no sanitario de un centro hospitalario.

Levels of cholesterol (CT) and lipoproteins fractions (c-LDL and c-HDL), as well as the atherogenic index (CT/c-HDL), were assessed in 307 workers of a health center. The study population was classified into groups, based on age and sex and whether they were health (physicians, registered nurses, clinical assistants) or non-health staff. The lipidic profile of the health staff groups was similar to the profile of non-health staff groups of the same age and sex. The percentage of subjects with CT above 200 mg/dl. was significantly higher (79.6 vs 60.9%) (p < 0.05) among the male health staff versus the male non-health staff and lower among the female health staff versus the female non-health staff (34.5 vs 55.5%) (p < 0.05). The differences in the lipidic profile depending on age and sex were confirmed grouping the population on the basis of such criteria. We highlight that all groups, with the exception of the female health staff, had CT levels above those recommended by the WHO and we stress the need of making health professionals aware of the importance of a primary prevention plan for the control of the cholesterolemia.

[The usefulness of cholesterol determination in the etiology of pleural effusion]. / Utilidad de la determinación del colesterol en la etiología del derrame pleural.

95 pleural effusions of different etiology were studied. 25 were transudate, 22 neoplastic, 28 caused by tuberculosis, and 20 miscellaneous. The Light parameters (pleural protein/plasma) (Prot LP/P), Pleural LDH (LDH LP) and LDH pleural/plasma quotient (LDH LP/P) were determined and compared with the efficacy of pleural cholesterol (Chol LP) and pleural cholesterol/plasma quotient (Chol LP/P) to differentiate the transudate from pleural exudate. With Prot LP/P quotient the sensitivity was of 85% and the specificity 91.6%; with LDH LP the sensitivity was of 74.6% and the specificity 97.6%. With the LDH LP/P quotient the sensitivity was of 89% and the specificity 87.8%. The sensitivity of each parameter was similar to that obtained by Light but less specific. All the transudates had levels of chol LP lower than 55 mq/dl (100% specificity) with a sensitivity of 84%. The Chol LP/P quotient had a limit of 0.3, this being its sensitivity of 91.3% and 93.1% its specificity. The presence of both parameters were necessary to the classification and the sensitivity obtained being of 80.3% and the specificity 100%. We concluded that the determinations of Chol LP and the Chol LP/P quotient are of great advantage in differentiating the pleural transudate from pleural exudate and the predictive value is, at least, similar to that obtained by Light.

[Sublingual enalapril in hypertensive crisis. A preliminary study]. / Enalapril sublingual en crisis hipertensiva. Estudio preliminar.

The effects of a new angiotensin I-converting enzyme inhibitor (ACEI), enalapril via sublingual was studied in 16 patients (median age 60.5 +/- 8.7 years). 10 were female and 6 male with hypertension crisis defined as systolic pressure (SP) greater than or equal to 220 mmHg and/or diastolic pressure greater than or equal to 120 mmHg (DP). We observed a significant decrease of SP and DP 20 min after the enalapril administration, without affecting the cardiac rate (p less than 0.001). This decrease was maintained during 30 and 60 min (p less than 0.001). Secondary effects were not observed. We concluded that sublingual enalapril can be a useful drug in hypertension crisis when not an urgent life compromising situation in elderly patients, because of its gradual hypotensive and maintained effect, allowing the commencement of an oral treatment.

[Neoplasm of the ovary as a cause of hyperamylasemia]. / Neoplasia de ovario como causa de hiperamilasemia.

A case of hyperamylasemia produced outside the pancreas and of exceptional origin, is presented. The place of origin is an ovarian carcinoma whose first manifestation was acute abdominal pain. The blood level of amylase was slightly increased mainly in its salivary fraction detected by the chromogenic/inhibition technique. This level, followed the tumor evolution and decreased in parallel to the tumor's response treatment.

[Dyslipemia in physicians. The need for a plan of primary prevention of atherosclerosis in our country]. / Dislipemia en médicos. Necesidad de un plan de prevención primaria de ateroesclerosis en nuestro medio.

A comparative study of the total cholesterol (TC) and its fractions was carried out in 3 groups of males. The first group consisted of (C) 53 healthy males (18 between 30-39 years old, 17 between 40-49 and 18 between 50-65); the second group (M) was of 57 male doctors (19 between 30-39 years old, 21 between 40-49, and 17 between 50-65); third group (E) was of 94 males with myocardial infarction (22 between 30-39 years old, 32 between 40-49, and 40 between 50-65). TC was significantly lower (p less than 0.02 and p less than 0.001) in both the lower ages ranges in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower (p less than 0.001) in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower HDL-C (p less than 0.01) and to group M in the lowest age range (p less than 0.005). LDL-C was significantly higher (p less than 0.001) in Group M compared to C in the higher age range. VLDL-C was higher (p less than 0.05) in Group E compared to C in both the higher age ranges (p less than 0.05) as well as to the middle age range of Group M (p less than 0.05). The indexes TC/HDL-C and LDL-C/HDL-C were significantly higher in Group E compared to Groups C and M in all age ranges. These indexes were significantly higher (p less than 0.01 and p less than 0.05) in Group M compared to group C in all age ranges.(ABSTRACT TRUNCATED AT 250 WORDS)

Timeliness of care and prognosis in patients with lung cancer.

BACKGROUND: Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. AIMS: To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. METHODS: A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival. RESULTS: A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay. CONCLUSIONS: The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.